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2014 CODING UPDATE. Increases. RVU ( Medcr ) EM office visits (99xxx) +3% Ophthalmic office visits (92xxx) +6% Ext. Ophthal . (92225/6) +5% ($28/$25) Topography (92025) +6% ($38) Foreign Body, Conj. (65205) +6% ($58)

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increases
Increases

RVU (Medcr)

EM office visits (99xxx) +3%

Ophthalmic office visits (92xxx) +6%

Ext. Ophthal. (92225/6) +5% ($28/$25)

Topography (92025) +6% ($38)

Foreign Body, Conj. (65205) +6% ($58)

Cornea puncture, tattoo (65600) +6% ($411)

Probe canaliculi(68840) +7% ($135)

decreases
Decreases

RVU (Medcr)

Fundus Photo (92250) -6% ($81)

Cornea FB w/SL (65222) -7% ($70)

Fit CL for ocl. surface dx (92071) -10% ($34)

Cat. Sx. w/ IOL (66984-55) -12% ($134)

Photo, External (92285) -14% ($21)

Visual Field, Extnd. (92083) -26% ($67)

Photo, Specular Micrscpy(92286) -69% ($39)

amniotic membrane
Amniotic Membrane

65778 Placement of of amniotic membrane on the ocular surface for wound healing; self-retaining

Recurrent corneal erosion, infectious/inflammatory keratitis, herpes, superficial epithelial defects, severe dry eye, cornea disease.

amniotic membrane1
Amniotic Membrane

For healing persistent epithelial defects, ulcers. When bandage CL needed, want inflammation control, but cant use steroid.

$1469 (Medcr) Cost $800

Paid by Medicare in several states.

amniotic membrane2
Amniotic Membrane

Bio-Tissue PROKERA www.biotissue.com

scanning laser for plaquenil
Scanning Laser for Plaquenil

V58.69 Long term (current) use of other medications; Other high-risk medications

Nine Medicare Part B contractors:

6 approve V58.69 (Novitas, CGS, First Coast, NGS, NHIC, WPS). Three (Cahaba, Noridan, Palmetto) are silent about V58.69 -- they have no LCD for OCT.

scanning laser for plaquenil1
Scanning Laser for Plaquenil

States with Cahaba, Noridan, Palmetto: if 92134 with V58.69 is denied (as in the past), submit an appeal, giving evidence that Novitas, CGS, First Coast, NGS, NHIC, WPS pay for V58.69. Chances are good the contractor will reverse its decision and it will be paid.

medicare
Medicare

MEDICARE PAYMENT REDUCTION PROGRAMS:

OPPS, MPPR, SEQUESTRATION

medicare1
Medicare

OPPS - Medicare put payment cap on some diagnostic imaging services, based on fee caps of Hospital Outpatient Prospective Payment System (OPPS).

The only optometric code affected is 92250 Fundus Photography.

medicare2
Medicare

MPPR - Medicare reduces payment on some diagnostic ophthalmology procedures, when two (or more) are billed on the same day.

The MPPR (Multiple Procedure Payment Reduction) reduces payment on the 2nd code (and the 3rd, 4th, etc).

medicare3
Medicare

MPPR –

The first diagnostic procedure is paid at the normal rate. The first diagnostic procedure is defined as the one with highest value.

medicare4
Medicare

MPPR –

76514 Pachymetry

92025 Corneal topography

92060 Sensorimotor exam

92083 Visual field, extended

92132 Scanning imaging, anterior segment

92133 Scanning imaging, optic nerve

92134 Scanning imaging, retina

medicare5
Medicare

MPPR –

92250 Photo, fundus

92285 Photo, external

92286 Photo, specular endothelial microscopy

file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsx

medicare6
Medicare

SEQUESTRATION - Federal budget problems resulted in an overall 2% reduction of physician pay.

Medicare pays the physician 78% of the allowed payment, and the patient still owes 20% of the Allowed Payment.

Allowed Payment remains the same.

file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsx

using glaucoma stage code
Using Glaucoma Stage Code

Select ICD code for type of glaucoma (same as past) from 38 glaucoma codes (365.xx)

slide18

If selected code is one of 11 (below), add Glaucoma Stage code in 2nd position on claim form

365.10 Open-angle glaucoma, unspecified

365.11 Primary open angle glaucoma

365.12 Low tension glaucoma

365.13 Pigmentary glaucoma

365.20 Primary angle-closure glaucoma, unspecified

slide19

365.23 Chronic angle-closure glaucoma

365.31 Corticosteroid-induced glaucoma, glaucomatous stage

365.52 Pseudoexfoliation glaucoma

365.62 Glaucoma associated with ocular inflammations

365.63 Glaucoma associated with vascular disorders

365.65 Glaucoma associated with ocular trauma

slide20

Select Glaucoma Stage code (physicians judgment)

365.70 Glaucoma stage, unspecified

No documentation regarding stage of glaucoma

365.71 Mild stage glaucoma

Optic nerve changes consistent with glaucoma

No VF loss on white-on-white perimetry

VF loss may be on short-wavelength automated perimetry or frequency-doubling perimetry

slide21

365.72 Moderate stage glaucoma

Optic nerve changes consistent with glaucoma

VF loss in one hemifield

Not within 5° of fixation

365.73 Severe stage glaucoma

Optic nerve change consistent with glaucoma

VF loss in both hemifields

VF loss within 5° of fixation in at least one hemifield

slide22

365.74 Indeterminate stage glaucoma

Glaucoma stage cannot be determined

Had no time to do VF

Patient can’t do VF

VF unreliable or uninterpretable, so stage of glaucoma is unsure

Do not confuse 365.74 with 365.70 which is no documentation regarding stage of glaucoma

bilateral glaucoma
Bilateral Glaucoma

Same type and stage

Report one code for type of glaucoma, and one Glaucoma stage code

Same type but different stage

Report one code for type of glaucoma, and one Glaucoma stage code for the highest glaucoma stage

Each eye different type and different stage

Report two codes, one for each type glaucoma, and one Glaucoma stage code for highest glaucoma stage

claim form
Claim Form

Enter stage code adjacent to glaucoma diagnosis

Report with office visit code and every related procedure done during visit

secondary codes
Secondary Codes

Glaucoma stage codes are secondary add-on codes

Glaucoma stage codes are not principal or first-listed or primary diagnosis codes

hipaa
HIPAA

Adherence to ICD guidelines is required by HIPAA

HIPAA applies to anything transmitted electronically

Some plans may be slow to recognize new codes

payment if not reported
PAYMENT IF NOT REPORTED?

Florida MAC says Yes

Noridian?

WPS?

Non-Medicare?

information
INFORMATION

Teaching tool by AGS

http://www.americanglaucomasociety.net/professionals/glaucoma_staging_codes_teaching_module/

Google “American Glaucoma Society”

cpt codes
CPT CODES

Deleted 2012

92070

Fitting of contact lens for treatment of disease, including supply of lens

cpt codes1
CPT CODES

New 2012

92071

Fitting of contact lens for treatment of ocular surface disease

Report supply of lens separately with 99070 or V code

cpt codes2
CPT CODES

New 2012

92072

Fitting of contact lens for management of keratoconus , initial fitting

Report supply of lens separately with 99070 or V code

Subsequent fittings, report 99 or 92 office call code

remote imaging
Remote Imaging

New in 2011

Remote imaging for detection of retinal disease

and

Remote imaging for monitoring and management of active retinal disease

remote imaging1
Remote Imaging

New in 2011

92227 Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision,

unilateral or bilateral.

remote imaging2
Remote Imaging

92227

This code has no physician work and is intended for use by non-physician readers

For detection or screening for retinopathy

Used when it is unknown if patient has retina disease - just looking for it

remote imaging3
Remote Imaging

New in 2011

92228 Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report,

unilateral or bilateral.

remote imaging4
Remote Imaging

92228

When patient has active retinopathy being managed

For physicians involved with remote imaging

remote imaging5
Remote Imaging

92228example

Separate entity (egreading center) owns imaging system

It is placed in PCP office

PCP staff takes image

remote imaging6
Remote Imaging

92228example

Image is sent to OD/OMD for I&R

or

Reading center staff provides I&R, under physician supervision

PCP bills w/ TC,

OD/OMD/Reading center bills w/ 26

remote imaging7
Remote Imaging

92228example

92228-26 $21.43 (Medicare 2013)

deleted cpt
Deleted CPT

92120 Tonography; recording indentation tonometer or perilimbal suction

92130 Water provocation tonography

icd 10
ICD-10

ICD-10-CM

October 1, 2014 implementation

icd 101
ICD-10

ICD-10-CM “Benefits”

  • Measure quality, safety, efficacy of care
  • Reduce need for attachments to explain pt’s condition
  • Design payment systems & process claims for payment
  • Conduct research, epidemiological studies, clinical trials
  • Setting health policy
  • Operational and strategic planning
  • Designing health care delivery systems
  • Monitor resource use
  • Improve clinical, financial, administrative performance
  • Prevent and detect health care fraud and abuse
  • Track public health and risks
tearlab osmolarity test
TearLab Osmolarity Test

Waived Test Approval

Effective January 1, 2012

CMS pays 83861 in each state $23.25 per eye

dmepos
DMEPOS

Fee

January 1, 2013 application fee for CMS 855S for enrollment or revalidation with DME is $523

Fee will remain $532 until December 31, 2013

(was $505, $523)

dmepos1
DMEPOS

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Can you sell post cataract glasses if not a provider?

medicare cf
Medicare CF

Conversion Factor

34.023

January 1, 2013 to December 31, 2013

medicare abn
Medicare ABN

Advanced Beneficiary Notice

ABN Form CMC-R-131 (03/11)

Only acceptable version after January 1, 2012

slide48
LCD

file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/LCD/LCD Aug 13.pptx